Bullinger Katie L, Crudele Angela N, Morrell Martha J, Johnson Lise
Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA.
Epilepsia Open. 2025 Aug;10(4):1099-1110. doi: 10.1002/epi4.70069. Epub 2025 Jun 5.
To leverage RNS® System chronic thalamic EEG recordings to compare ictal and interictal thalamic electrophysiology in idiopathic generalized epilepsy (IGE) and Lennox-Gastaut Syndrome (LGS).
As part of ongoing clinical trials in IGE and LGS, intracranial EEG data were acquired from the centromedian nucleus (CM) bilaterally. Ictal recordings were evaluated by trained epileptologists for preictal and ictal onset patterns. The number of detections and the frequency characteristics of interictal and ictal activity were compared across groups.
Ictal activity was clearly observed in the CM in IGE and LGS. Detections of interictal epileptiform activity and electrographic seizures were more frequent in LGS. Interictal frequency peaks had similar characteristics across cohorts, although low frequencies were more frequent in LGS. All participants with LGS had 2 or more ictal onset patterns. Most often, onset patterns were similar bilaterally. However, 20% of participants had some seizures with different onset patterns on the right and left, and 50% had some seizures that were unilateral. Low voltage fast activity was the most common onset pattern, followed by bursts of polyspikes and then rhythmic <13 Hz activity. In IGE participants, rhythmic <13 Hz activity was the most common ictal onset pattern; spike and wave was the next most common onset pattern. Two additional onset types were observed: polyspike onset and high amplitude delta followed by low amplitude fast activity onset. Onset patterns were generally consistent within an individual; only 20% of participants had multiple seizure onset types.
Differences in interictal background are consistent with the known phenotypes of IGE and LGS. Furthermore, CM recordings of ictal activity in both cohorts support the feasibility of closed-loop stimulation, with detection settings programmed according to each individual's seizure onset pattern.
The RNS® System was used to record brain activity from the thalamus in people with idiopathic generalized epilepsy (IGE) and Lennox-Gastaut Syndrome (LGS). Seizure-related activity was detectable in the thalamus in both groups, with detections of abnormal activity more frequent in LGS. LGS participants often had varied seizure onset patterns, while seizure onset patterns were more consistent in IGE. These findings align with known differences between IGE and LGS and suggest that thalamic recordings can guide personalized seizure detection. This supports the potential for using closed-loop brain stimulation tailored to individual seizure patterns to improve epilepsy management.
利用RNS®系统慢性丘脑脑电图记录，比较特发性全身性癫痫（IGE）和Lennox-Gastaut综合征（LGS）发作期和发作间期的丘脑电生理。
作为IGE和LGS正在进行的临床试验的一部分，从双侧中央中核（CM）获取颅内脑电图数据。由训练有素的癫痫专家评估发作期记录的发作前期和发作期起始模式。比较各组间发作间期和发作期活动的检测次数及频率特征。
在IGE和LGS的CM中均清晰观察到发作期活动。LGS中发作间期癫痫样活动和脑电图发作的检测更为频繁。尽管LGS中低频更为常见，但各组间发作间期频率峰值具有相似特征。所有LGS参与者有2种或更多发作期起始模式。大多数情况下起始模式双侧相似。然而，20%的参与者有一些发作在左右两侧起始模式不同，50%的参与者有一些发作是单侧的。低电压快活动是最常见的起始模式，其次是多棘波爆发，然后是节律性<13Hz活动。在IGE参与者中，节律性<13Hz活动是最常见的发作期起始模式；棘慢波是其次最常见的起始模式。还观察到另外两种起始类型：多棘波起始和高波幅δ波后接低波幅快活动起始。起始模式在个体内通常一致；只有20%的参与者有多种发作起始类型。
发作间期背景的差异与IGE和LGS的已知表型一致。此外，两组发作期活动的CM记录支持闭环刺激的可行性，其检测设置根据每个个体的发作起始模式进行编程。
RNS®系统用于记录特发性全身性癫痫（IGE）和Lennox-Gastaut综合征（LGS）患者丘脑的脑活动。两组在丘脑中均能检测到与发作相关的活动，LGS中异常活动的检测更为频繁。LGS参与者的发作起始模式通常多样，而IGE中发作起始模式更为一致。这些发现与IGE和LGS之间的已知差异相符，并表明丘脑记录可指导个性化的发作检测。这支持了根据个体发作模式定制闭环脑刺激以改善癫痫管理的潜力。
